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Breast cancer patients undergoing mastectomy increasingly expect excellent cosmetic results after breast reconstruction. A type of biomaterial called acellular dermal matrix (ADM) is now helping surgeons when revision surgery is needed after breast reconstruction, according to a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). ­

ASPS Member Surgeon Dr Scott L. Spear and colleagues of Georgetown University Hospital report good results with techniques using ADM for revision breast reconstruction. They write, ‘ADM has proven to be a reliable tool in managing some of the most common and challenging problems in implant-based breast reconstruction.’

High success rate

Over a 5-year period, Dr Spear and colleagues used ADM as part of revision surgery for cosmetic improvements and other problems developing after breast reconstruction. Acellular dermal matrix is made from skin from which the cells have been removed, leaving behind a sterile framework or ‘lattice’ of tissue that the patient’s own cells can grow into and eventually replace.

The researchers report their experience with ADM in a total of 135 breast reconstruction procedures. The most common uses were to address problems affecting the appearance of the lower breast. These were either to correct the fold under the breast (inframammary fold) in 37% of cases, or to provide support in 26% for the lower pole of the breast.

In 27% of cases, ADM was used to manage hardening (contracture) of the capsule around the breast implant. Less commonly, ADM was used to manage problems related to ‘rippling’ or incorrect positioning (symmastia) of the implant.

Revision procedures using ADM were highly successful and safe. The overall success rate was 95.5%, with a complication rate of just 5%. Further surgery was needed in only about 1% of cases — a much lower rate than in premarket studies of ADM for repeat breast augmentation surgery.

Helping to meet expectations for good cosmetic results

Originally developed as an alternative to skin grafting in burn patients, ADM has proven useful in various types of reconstructive surgery, including initial breast reconstruction following mastectomy. In the authors’ experience, using ADM for revision implant breast reconstruction was a natural outgrowth of its use in immediate breast reconstruction.

Techniques using ADM are particularly helpful at a time when patients and surgeons alike are demanding a better final appearance with breast reconstruction, Dr Spear and co-authors believe. They write, ‘Increased patient expectations have blurred the line between reconstructive and aesthetic breast surgery, challenging surgeons to find innovative and reproducible ways to create favourable, reproducible, and durable results, similar more and more to the results obtainable with cosmetic breast surgery.’

In their article, Dr Spear and colleagues briefly outline their techniques using ADM to manage specific problems. Their experience suggests that ADM is a useful and versatile tool for addressing common concerns arising after implant-based breast reconstruction. The researchers conclude, ‘Although there were complications, there was a high frequency of success in managing these challenging problems.’